How to Complete the Initial Paperwork for Medical Billing

As a biller and coder, completing the initial paperwork is the first step in the medical billing scenario. When you walk into the office of any healthcare provider, be it a family physician, a testing lab, or the emergency room, what’s the first thing you do? You walk up to the desk and check in, of course.

During the check-in, a couple of things happen:

The patient completes a demographic form. This form identifies the patient name, birthdate, address, and Social Security number or driver’s license number. The form should also indicate who the policyholder of the insurance is and what that person’s relationship is to the patient. If the policyholder is someone other than the patient, then the same information (name, birthdate, and so on) should be obtained about the policyholder, as well.

Copy the patient’s insurance card at each encounter, both front and back, when you request the demographic form.

You verify the patient’s identity by asking for a government issued photo ID. Thanks to a proliferation of insurance fraud and identity theft (thanks, technology!), you need to make sure that the patient who brings in an insurance card is actually the insured member.

Using another individual’s insurance coverage is fraud, and a provider who submits a claim that misrepresents an encounter is also committing fraud. So be alert and double-check the ID the patient hands you, because every provider is responsible for verifying patient identity and could be held liable for fraud committed in the provider’s office.

You verify whether the patient needs a referral or a preauthorization. You may need to check these early.

You verify benefits. Here are some benefit-related questions to ask upfront:

Is there a copay? If so, the provider is normally expected to collect that amount up front.

Is there any unmet deductible? If the patient has an unmet deductible, the provider may want to ask for all or part of that up front.

Is the patient out-of-network, and if so, what are his out-of-network benefits?

You collect any copayments, deductibles, or co-insurance obligations. If the provider encounter is a procedure to which a deductible or co-insurance obligation may be incurred, these amounts may also be collected up front.

After the initial paperwork is complete, the next step of the revenue cycle is the actual patient encounter with the service provider or physician.

Following the encounter, the provider documents the billable services. This documentation includes what was done, the reason the service was medically necessary, and any additional information that the physician feels is relevant to the patient’s care. In the past, the charts were paper, and the documentation was usually handwritten. Today, providers are moving toward electronic health records.